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JAMA Surgery Clinical Challenge

Abdominal Pain and a Biliary Abnormality

Image of Figure 1

Figure. Magnetic resonance cholangiopancreatography (A) and abdominal computed tomography (B) revealing a cystic lesion in the region of the porta hepatis (arrowheads). F indicates feet; H, head; L, left; and R, right.

James L. Crawford, MD
Michael J. Pucci, MD
Charles J. Yeo, MD
Harish Lavu, MD

A 30-year-old female immigrant from Laos was referred to our institution after admission to an outside hospital for right upper quadrant abdominal pain with associated nausea and vomiting. Her imaging results from the outside hospital included abdominal magnetic resonance cholangiopancreatography revealing a cystic abnormality in the region of the porta hepatis (Figure, A). The patient denied any previous medical or surgical history. On examination, the patient had mild right upper quadrant tenderness to palpation without signs of peritonitis. Routine laboratory values were within normal limits, except for a mildly elevated amylase level. A computed tomographic scan was obtained to further delineate the abnormality (Figure, B).

See the full article for an explanation and discussion.

Author Affiliations: Crawford, Pucci, Yeo, and Lavu (harish.lavu@jefferson.edu) are affiliated with the Department of Surgery, Thomas Jefferson University, and Jefferson Pancreas, Biliary, and Related Cancer Center, Philadelphia, Pennsylvania.